By Clare Crawford-Mason. Special to The Washington Post, Tuesday, April 23, 2002; Pg HE01; reprinted with permission from the author.
When my gynecologist's office called me and asked that I come in as soon as possible, I knew this was not good. But I could not have imagined the bizarre and dramatic odyssey I was beginning – or how frighteningly close several trusted doctors were to sending me to unnecessary, expensive and painful surgery. And there's no way I could have known how the deceased management guru with whom I'd spent more than a decade of my professional life collaborating would provide an essential piece of advice.
I had had my biannual in-office biopsy 10 days before. The procedure was done to determine whether my small daily dose of estrogen was causing cancer. While estrogen taken for menopausal symptoms can increase a women's risk of uterine cancer, adding progesterone can reduce that risk. But in my case the progesterone made me more irritable than taking no estrogen at all. So with my doctor's permission I kept taking the estrogen but quit taking the progesterone. The biopsies were done to keep an eye out for cancer.
When we met to discuss my biopsy results, my doctor said a lab report showed atypical cells in my uterus, a condition considered a precursor, or even an indicator, of cancer. She wanted me to immediately schedule a hysterectomy – a major surgery in which the entire uterus is removed.
I am 65 years old and have avoided all surgery since I had my tonsils out at 6. I asked if there were any alternatives. No good ones, she said. Besides, she said, after the surgery I would be able to take all the estrogen I wanted.
I could choose to have a D&C, she allowed, dilation and curettage, an extensive scraping of the uterine lining. This is a relatively minor, in-and-out procedure, but if results of that process revealed more atypical cells or cancer, I would have to have a hysterectomy anyway. And, she reminded me, if I had a D&C I would not be able to take any more estrogen afterward. I would still have my uterus and, therefore, would need to be tested for atypical cells and cancer regularly and indefinitely.
I said I would like a second opinion; she gave me two doctors' names.
I met one a week later. He read Lab Report and told me that I had a 1-in-4 chance of having cancer already – and that unless I wanted to have another child I should have the surgery to remove my uterus immediately. If I had wanted a baby or had been unhealthy, he told me, the alternative treatment would be long and risky, requiring repeated D&Cs, numerous tests and a life of medication – including the dreaded progesterone – until I finally had a hysterectomy.